KICKIN’ IT DANCE CO. REGISTRATION FORM
STUDENT’S NAME: ____________________________ DATE OF BIRTH: ________________
CITY: ______________________________ STATE: _____________ ZIP: ________________
PARENT’S NAME: ____________________________________________________________
HOME#:_________________ WORK#:____________________ CELL#:__________________
EMERGENCY CONTACT: ________________________PHONE#:________________________
RELATIONSHIP TO CHILD: _____________________________________________________
EMAIL ADDRESS: ____________________________________________________________
CREDIT CARD # _____________________________ EXP. ___________ VISA/MC/DISCOVER
•Registration Fee: $30 (Annually) / $50 Family •Each additional class is an additional fee.
•Tuition due date is the 1st day of the month. •15% discount for each additional sibling.
•Late fee of $25 after the 5th of month. •No refund for missed classes
•If month contains five weeks, classes will be held four of the five weeks.
•No street shoes •No street clothes •No gum
•5% Discount for paying quarterly.•10% Discount for paying yearly.
•Discounts are nonrefundable. •Return check fee $25.
•Performance Opportunity (costume must be purchased.)
•Studio will not be open on holidays.
•$15 late fee per month on any unpaid balances until account is paid in full
•We discourage parents from staying during class time
•Student Observation: Parents and guardians are encouraged to take interest in their child’s progress and will be provided a time in which to observe.
•Private lessons are available. If you miss, you will still be charged.
•No classes may be missed 2 weeks prior to any performance.
•Dress code: Proper dress is required for all classes, including shoes. Saggy pants will not be allowed.
•Attendance: Regular attendance is necessary to provide the best dance education possible. Therefore, students who cannot conform may not be included in performances due to lack of rehearsals and can be dropped to a lower level, if necessary.
•Students will need to arrive on time, as they perform proper warm up routines, thus preventing injuries.
•Parents and guardians are not allowed in classroom during classes.
•Pick students up promptly, as students are not allowed to leave studio without supervision. If children are left for more than 10 minutes, a $25 fee will be charged to your account.
•After completing a registration form, a slot is reserved and parent/guardian is accountable for all payments until paid in full.
•If you wish to discontinue dance at KDC, it must be done prior to the beginning of the month & be in writing to the director. Tuition will not be pro-rated for missed classes, or discontinued attendance.
•ALL PAYMENTS WILL BE SENT ELECTRONICALLY. THE FUNDS FOR YOUR PAYMENT WILL BE DEBITED
FROM YOUR ACCOUNT THE 1ST WEEK OF EVERY MONTH. IF FUNDS ARE NOT AVAILABLE WHEN CHARGED, A $25 FEE WILL BE CHARGED TO YOUR ACCOUNT.
I, the undersigned parent and/or legal guardian of ______________________________________________, a minor (the “Minor”), hereby consent to the Minor’s participation in and proximity to KICKIN’ IT DANCE CO. and dance instruction and any and all related activities (collectively, the “Activities”). I understand and acknowledge that KICKIN’ IT DANCE CO. has consented to the Minor’s participation in the activities expressly subject to my execution of this Consent and Release (the “Release”) and my performance of each of the obligations described in this Release.
In consideration of the Minor being permitted to participate in or be in proximity to the activities, I, being of lawful age, do for myself, my spouse, heirs, executors, administrators, representatives, and assigns, and as parent and/or legal guardian of the Minor, and for the Minor’s heirs, legal representatives and assigns, hereby release and forever discharge KICKIN’ IT DANCE CO., its managers, members, employees, agents, and affiliates, and each of them (collectively, the “Releases”) from and waive, relinquish and discharge each and every release of any and all claims, demands, action, damages, and liabilities of every kind and character whatsoever resulting in any manner from my Minor’s participation in or proximity to the Activities, whether in law or in equity, whether known or unknowns, whether anticipated or unanticipated, whether caused by the negligence of any Releases or otherwise, and whether resulting in bodily or personal injury, death, or property damage.
I also authorize KICKIN’ IT DANCE CO. to use pictures taken of the student, for use on the KICKIN’ IT DANCE CO. website.
I have read, understand, and agree to abide by the policies as outlined on the following pages of this form. I/We agree to pay all attorney fees, court costs, filling fee, including charges or commissions up to 50 percent of principal balance that may be assessed to any collection agency retained to pursue past due balances. I/We further agree to pay all late fees.
Parent’s Signature: _________________________Class(es) student signed up for:
Date: ____________________________________ _______________________________